The current (26 May 2005) issue of Nature focuses on avian flu and the possibility of a pandemic. They've chosen to illustrate how a flu pandemic might play out with a future scenario in the form of a blog. While WorldChanging has written beforeabout both the hype and reality of a possible pandemic, the Nature piece is worth reading -- especially as an example of how scenarios and blogs as narrative vehicles continue to trickle up through traditional media.

2 February 2006 The virus spreads

Today, I was at a press conference at the National Institutes of Health in Bethesda. A guy from the CDC pointed to a giant screen, a map of the world dotted with red pixels. He said that they'd reckoned the virus might hit in two or more waves up to eight months apart, as in past epidemics. They'd hoped the first pandemic strain of H5N1 might be poorly contagious, and come back again with a vengeance after it had picked up more infectivity. By that time we might have had a vaccine. That was just a hunch, though. And it was wrong.

The mild pandemic in 1968 took almost a year to cross the globe. This one probably started around October. So we're now almost four months in. Look at that map! With the huge increase in passengers travelling by air, it's already lodged in 38 cities around the globe. The outline of Asia is barely visible beneath the swarm of red pixels.

Now the virus is in coastal cities on both sides of South America. It hit Europe two weeks ago, ripping through Paris in just 11 days. In the French capital alone, there were 2.5 million cases and 50,000 dead. That's par for the course  infection rate 25% and mortality 2%, similar to the 1918 pandemic. Extrapolate these numbers, and we're going to have over 30 million dead worldwide. In poor and densely populated countries like India, it could be worse.

Where's next, I asked. Based on passenger data  which had to be prised from the airlines  one epidemiologist was willing to make a guess. "Within two weeks, there." He traced his finger from San Diego to Los Angeles, up to San Francisco. Within another three to four weeks, it'll be the turn of the conurbations along the eastern seaboard.

While the scenario largely has a Kunstlerian doomsday ring to it, it's a great exercise in bringing to life the information that is often buried as inputs or outputs to simulation models such as EpiSims. The piece concludes with a rueful look back at how unprepared we were/are here in mid-2005. At their best, these scenaric glimpses of possible futures can shed new light on the present, revealing early warning signs and looming decisions that may turn us away from or towards the imagined events.

I appreciate your criticisms of Kunstler, and often agree with them. But I really don't think it's appropriate in this context.

I don't think you want to use "Kunstlerian" as the new synonym for "scaremonger" or "Chicken Little." It sounds reflexive and personal, rather than thoughtful. It's also an unfair criticism of the story in question, which studiously avoids the worst-case assumptions relating to H5N1.

I object to assumptions that a future pandemic of H5 influenza would be "mortality 2%, similar to the 1918 pandemic." Some say the Spanish flu had a mortality rate of 5%. Furthermore, the current mortality for the H5N1 avian virus in Vietnam is over 50%! Even the Quighan outbreak (currently denied by China, but confirmed by detailed fatality lists posted on the internet) seems to have a lethality above 25%! Wheither it is 2% or 25% lethal is a VERY IMPORTANT point of argument.

Posted by: Brad Arnold on 29 May 05

AMMA (Mata Amritanandamayi Devi) had predicted in 2001 that 2005 would be a very bad year for us. When the tsunami happened, She warned that more catastrophes were in store.

Thank you so much for your blog. You are doing wonderful work offering the public a glimpse into what possible future could await us; something inconceivable for most of us. We need to be made aware of where our public health systems are broken, how we can repair them and what we, as the private sector can do, to both protect ourselves and facilitate that process. (I recently heard from a public official that Marshal Law would be imposed at the first signs of the disease in our city. He freely admitted, it might not work. There are always those who refuse the directive.)

When we split hairs over mortality rates and such, we engage in an exercise of distraction-- More importantly, this will not be the last flu pandemic to hit. There will be others, with mortality rates all over the map. Will we be ready? Please, keep writing! I am interested in how cities will deal with this. How they plan to protect their citizens and what we can do as individuals, to protect our families.

Posted by: Elisabeth S. on 29 May 05

Thank you so much for your blog. You are doing wonderful work offering the public a glimpse into what possible future could await us; something inconceivable for most of us. We need to be made aware of where our public health systems are broken, how we can repair them and what we, as the private sector can do, to both protect ourselves and facilitate that process. (I recently heard from a public official that Marshal Law would be imposed at the first signs of the disease in our city. He freely admitted, it might not work. There are always those who refuse the directive.)

When we split hairs over mortality rates and such, we engage in an exercise of distraction-- More importantly, this will not be the last flu pandemic to hit. There will be others, with mortality rates all over the map. Will we be ready? Please, keep writing! I am interested in how cities will deal with this. How they plan to protect their citizens and what we can do as individuals, to protect our families.

Posted by: Elisabeth S. on 29 May 05

Thank you so much for your blog. You are doing wonderful work offering the public a glimpse into what possible future could await us; something inconceivable for most of us. We need to be made aware of where our public health systems are broken, how we can repair them and what we, as the private sector can do, to both protect ourselves and facilitate that process. (I recently heard from a public official that Marshal Law would be imposed at the first signs of the disease in our city. He freely admitted, it might not work. There are always those who refuse the directive.)

When we split hairs over mortality rates and such, we engage in an exercise of distraction-- More importantly, this will not be the last flu pandemic to hit. There will be others, with mortality rates all over the map. Will we be ready? Please, keep writing! I am interested in how cities will deal with this. How they plan to protect their citizens and what we can do as individuals, to protect our families.

Posted by: Elisabeth S. on 29 May 05

As someone whos parents/grandparents lived through several of the last pandemics the world faces I have to point out its very likely that when not if but when the next SERIES of pandemics hit in the end horrible as it may seem we will be better off for it.

Posted by: wintermane on 30 May 05

How to protect cities. How to protect tourist places. How to protect poor countries. Many questions so we need to start thinking like ants, maybe on a wiki - not a wiki for encyclopaedic knowledge, but one for massive news on What goes on, and massive creativity on What can we do.

How can blogs help? We are going to need to share knowledge, information (http://www.promedmail.org is not going to be enough), wisdom and creativity. We've read, here on WC, about filters for water - could we have filters for air? Easily made and affordable? Talk about design restrictions!

There is no way to "protect" a modern dense city the only methods that have ever realy worked involve quaranteening what cities become infested and waiting for the contagion to burn itself out. There realisticly is no way to do the opposite and protect a city from outside contagion as a city just need too much stuff from the outside to get along.

As for tourist traps... its fairly self regulating realy as soon as the news of plague/doom hits common knowledge tourism nosedives and other then plague riddled tourists heading home spreading horror as they go it does shut down that vector rather fast.. well other then the weird people who tour plague areas... But then such people will get darwined out sooner or later as the number of plagues increases and the number of dim bulbs dwindles...

And yes I know im a heartless cold cruel bastard duh im a conservative after all;/

Posted by: wintermane on 31 May 05

Ok, I'll rephrase.

"Protect" means "slow down". WHO writes there's no way to avoid a pandemic once it starts. But we need to find ways to slow down transmission, in order to buy time.

For a hospital, it's not the same to have 100 patients a day or 1000 patients a day. So slowing down things does matter.

I think we need to think creatively on ways to slow down a pandemic. And that has to be done differently in different environments - just a guess.

Protect also means "keep society going" (as best we can) even if there's a pandemic going on.

How do we do business, keep in touch with friends, buy food, etc?

Once it starts, a flu pandemic takes a couple of years to unfold. The first 2-5 months are probably the worst ... unless we also count the following 2-5 months and so on.

A flu pandemic is really worldchanging. So what tools do we need (societal, high tech, low tech ...)? Could preparing for "that" be good for other kinds of changes we also want to see in the world? I suggest let's use Open Space, World Cafe, Appreciative Inquiry, Lateral Thinking or whatever it takes.

Oks the simple tho not cheap way to slow down the spread is to offer cheap isolation suits to people so they can keep from catching it. A simple durable all over covering with filter mask should keep people safe enough while out and about or working and as soon as a plague hits im sure a few hundred million people will be more then willing to pay 50 bucks or so to buy em. Something like a track suit jumpsuit filter mask hood combo should do the trick as long as it can keep the bugs out and not be a nightmare to wear.

That plus some super strong hepa filtering air cleaners for office decontam and grocery store germ containment might be a good idea.

Just need some tec ideas that can be made and put into production fast enough to catch a plague on the upswing before too many are walking dead. Hell even something as simple as a nose and eye and mouth guard to keep others germs away from your most vulnerable parts would help slow things down.. something cheap and comfortable that could be mass produced if needed. Also a germicidal glove that keeps you from spreading whats on your hands into your eyes mouth and nose... or at least makes it less likely.